Utilization Management Director jobs in Buffalo, NY

Utilization Management Director leads and directs the utilization review staff and function for a healthcare facility. Determines policies and procedures that incorporate best practices and ensure effective utilization reviews. Being a Utilization Management Director manages and monitors both concurrent reviews to ensure that the patient is getting the right care in a timely and cost-effective way and retrospective reviews after treatment has been completed. Provides analysis and reports of significant utilization trends, patterns, and impacts to resources. Additionally, Utilization Management Director consults with physicians and other professionals to develop improved utilization of effective and appropriate services. Requires a master's degree. Typically reports to top management. Typically requires Registered Nurse(RN). The Utilization Management Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be a Utilization Management Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)

Recently Added Utilization Management Director jobs

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Utilization Management Registered Nurse (RN)
  • CINQCARE
  • Buffalo, NY FULL_TIME
  • Utilization Management RN
    CINQ Connect NY LLC
    Position Description
    Overview
    The UM RN reports to the Director of Clinical Operations or designee, CINQ Care Inc., with accountability for effectively extending our care team approach by collaborating with hospitals, skilled nursing, and rehabilitation facilities to address inpatient care, discharge plans, and coordinate post discharge follow up on medical, social, and behavioral health needs via the phone and/or facility on-site visits. The UM RN should embody CINQ’s core values, including Imagination, Partnership, Forthrightness, Humility, Courage, and Relentlessness.
    Primary Responsibilities
    The UM RN will have the following responsibilities:
     
    • Daily, Weekly review of hospital/SNF individual patient medical records determining reason for admission, review of medical history, anticipating length of stay and discharge needs.  
    • Review and analyze the patient’s treatment plan and ensure that it is both effective, cost-efficient, and aligned with evidence-based medicine guidelines
    • Provide continuous review concurrently during the hospitalization and post discharge review by attaining the discharge summary to establish a personalized treatment plan.
    • Interface with patients, physicians, hospital discharge planners regarding the status of patient and recommend services that support discharge care.
    • Assist in discharge planning, helping patients transition from inpatient to at-home care
    • Coordinate patient care by directing to the most appropriate specialist or ancillary provider
    • Participate in Daily Hospital Census Rounds forum to discuss the patient’s inpatient status, anticipated discharge and create a post discharge care plan in conjunction with the PHN, Nurse Case Manager and PCP, leveraging others in the Care Team as required
    • Work with our medical providers, consulting the primary care provider for input, and refer the patient to that provider in real time whenever appropriate
    • Offer patient education when appropriate
    • Other duties as assigned

    General Duties
    The UM RN shall have following duties:
     
    • Leadership: The UM RN will lead the rounds sessions and offer solutions to deliver desired clinical and operational outcomes.

    • Collaboration: The UM RN will work closely with other clinical departments to learn their needs, internalize their knowledge, to achieve the clinical objectives of CINQ Care Inc.
     
    • Knowledge: The UM RN will provide clinical solutions and use the subject matter expertise of the Care Team to reduce hospital lengths of stay and assist with care coordination as patients return to the community.
     
    • Culture: The UN RN is accountable for creating a productive, collaborative, safe and inclusive work environment as part of the larger Company.
    Qualifications
    The UM RN should have the following qualification:
    • Education:  Active, unencumbered NY State License, Bachelor’s or equivalent degree in Nursing, Certification in Case Management preferred
     
    • Experience. Experience with utilization review either in the hospital or with a managed care company, at least one year of experience in a medical office preferred, Experience working with Excel, Word and EMR, Medent (preferred)
    • Entrepreneurial. CINQ seeks to fix gaps that have persisted for generations in the delivery of care to Black and Brown populations. This position is accountable for ensuring CINQ is positioned to innovatively deliver on its promise
     
    • Communication. Excellent verbal, written communication, and presentation skills; ability to clearly articulate and present concepts and models in an accessible manner to CINQ’s team, investors, partners, and other stakeholders. Proficiency in all Microsoft Office applications
     
    • Relationships. Ability to build and effectively manage relationships with clinical and business leaders and external constituents
     
    • Culture. Good judgement, impeccable ethics, and a strong team player; desire to succeed and grow in a fast-paced, demanding, and entrepreneurial Company.

    Location: Buffalo, NY
    Compensation: $71,000 - $81,000 annually
  • 1 Month Ago
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Director of Records and Information Management
  • Goldberg Segalla LLP
  • Buffalo, NY FULL_TIME
  • Goldberg Segalla, a dynamic and collaborative law firm with a national presence, seeks a highly motivated and organized individual to join its team as a Director of Records and Information Management ...
  • 1 Month Ago
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Director Revenue Cycle Management
  • Bertrand Chaffee
  • Springville, NY FULL_TIME
  • Director of Revenue Cycle Management, Springville NY Full Time. Days. Compensation is based on experience: 70k-100k annually Benefits: Health Insurance, Retirement Savings Plan, Paid Time Off and more...
  • 1 Month Ago
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Director, Product Management
  • PCB Piezotronics, Inc.
  • Depew, NY FULL_TIME
  • Primary Objective: The Director of Product Management is responsible for all aspects of sales, design and manufacturing of quality, profitable products for a division of PCB. Works with Senior Managem...
  • 1 Month Ago
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Director of Activities
  • Personal Healthcare Management LLC
  • Eden, NY FULL_TIME
  • Required: Split position between Eden / Dunkirk We offer the Following: Premium Compensation Great Benefits Package Fun, Family-Like Team, and Atmosphere! Work in a Beautifully Remodeled Office Profes...
  • 20 Days Ago
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Director of Nursing
  • Avante Care Management
  • Buffalo, NY FULL_TIME
  • The Director of Nursing is responsible for the clinical team of the facility, all aspects of the nursing department. Great Communication skills a must, organizational skills preferred. Great pay and b...
  • 23 Days Ago
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0 Utilization Management Director jobs found in Buffalo, NY area

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Accommodations Front Office- Starting at $15.00 per hour
  • Six Flags Darien Lake
  • Darien Center, NY
  • JOB STATEMENT Responsible for check- in processes in a timely and efficient manner at our Camp Gate, Hotel Front Desk, o...
  • 4/25/2024 12:00:00 AM
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Accommodations Night Audit- Starting at $16.00 per hour
  • Six Flags Darien Lake
  • Darien Center, NY
  • JOB STATEMENT Responsible for doing our nightly system maintenance, balancing revenue accounts, and problem solving anyt...
  • 4/25/2024 12:00:00 AM
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Senior Business Manager (Global Payment Solutions)
  • HSBC
  • Buffalo, NY
  • Job description Our purpose - Opening up a world of opportunity - explains why we exist. Here at HSBC we use our unique ...
  • 4/25/2024 12:00:00 AM
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Director of Housing
  • Community Services for Every1
  • Buffalo, New York, NY
  • The Director of Housing is responsible for daily oversight of the property management team including oversight of the pr...
  • 4/25/2024 12:00:00 AM
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Maintenance Dispatcher- Starting at $15.25 per hour
  • Six Flags Darien Lake
  • Darien Center, NY
  • JOB STATEMENT The Maintenance Dispatcher’s primary duties are to quickly and efficiently communicate between different a...
  • 4/24/2024 12:00:00 AM
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Program Director - Medical Legal Partnership
  • Neighborhood Legal Services Inc
  • Buffalo, NY
  • Job Description Job Description Neighborhood Legal Services, Inc. (NLS) is seeking a dedicated lawyer to lead an emergin...
  • 4/24/2024 12:00:00 AM
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Certified Nursing Assistant (CNA/No-Frills) Full-Time
  • McGuire Group Health Care Facilities
  • Hamburg, NY
  • Certified Nursing Assistant (CNA) No Frills Full-Time STARTING RATE: $18.97/hr. ($18.97 - $22.00/hr., dependent upon exp...
  • 4/23/2024 12:00:00 AM
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Esthetician
  • Local Medical Clinic
  • Clarence, NY
  • Job Description Job Description Internist’s office in Clarence looking for a Certified Esthetician. Sales and closing de...
  • 4/22/2024 12:00:00 AM
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About Buffalo, New York

Buffalo is the second largest city in the U.S. state of New York and the largest city in Western New York. As of July 2016[update], the population was 256,902. The city is the county seat of Erie County and a major gateway for commerce and travel across the Canada–United States border, forming part of the bi-national Buffalo Niagara Region. The Buffalo area was inhabited before the 17th century by the Native American Iroquois tribe and later by French settlers. The city grew significantly in the 19th and 20th centuries as a result of immigration, the construction of the Erie Canal and rail tra...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$123,019 to $166,347
Buffalo, New York area prices
were up 1.5% from a year ago
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What does a Utilization Management Director do?

Utilization Management Director in Johnstown, PA
Prior authorization decisions are also made using Medical Management and Behavioral Health Care Management internally derived policies and procedures developed using evidence-based guidelines based on national, state and locally established standards of practice.
March 01, 2020
Utilization Management Director in Carson City, NV
The utilization management coordinator must have strong project management skills to implement various programs within the allocated budget and set time limits.
January 31, 2020
Utilization Management Director in Melbourne, FL
Develops and administers polices and procedures for utilization control of inpatient and outside referral services countywide and for in a variety of categorical programs including the Medically Indigent Adult (MIA) Program.
January 08, 2020